What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome is a nerve problem that occurs when the Median nerve is compressed within the Carpal Tunnel. Nerves control muscles and allow us to feel sensations such as hot, cold, sharp and dull. When the Median nerve is compressed, it can cause severe pain and weakness in the wrist, hand and fingers.

Causes of Carpal Tunnel Syndrome

Since the Median nerve is the softest structure within the Carpal Tunnel, it is the most vulnerable to compression. Anything that decreases the available space for the nerve within the tunnel will cause nerve compression. As a result, there are many causes of Carpal Tunnel Syndrome. Examples include tumors, arthritic joints with bone spurs, tendonitis, inflammation and certain wrist positions. Repetitive wrist motions or repetitive gripping can lead to swelling and inflammation of the tendons within the Carpal Tunnel. As the tendons swell, they push the soft Median nerve against the firm roof of the tunnel, squishing it. This is referred to as Median nerve compression. If the nerve remains compressed, it begins to dysfunction and cause symptoms. If left untreated, the nerve damage will be permanent.

Causes of Carpal Tunnel Syndrome

Since the Median nerve is the softest structure within the Carpal Tunnel, it is the most vulnerable to compression. Anything that decreases the available space for the nerve within the tunnel will cause nerve compression. As a result, there are many causes of Carpal Tunnel Syndrome. Examples include tumors, arthritic joints with bone spurs, tendonitis, inflammation and certain wrist positions. Repetitive wrist motions or repetitive gripping can lead to swelling and inflammation of the tendons within the Carpal Tunnel. As the tendons swell, they push the soft Median nerve against the firm roof of the tunnel, squishing it. This is referred to as Median nerve compression. If the nerve remains compressed, it begins to dysfunction and cause symptoms. If left untreated, the nerve damage will be permanent.

Symptoms of Carpal Tunnel Syndrome

Severe or prolonged Median nerve compression causes it to dysfunction and results in classic symptoms of:

Hand and wrist pain:
» Aggravated by activity
» Aching or burning
» Often wakes you from sleep

Hand weakness and loss of dexterity:
» Frequently dropping things
» Poor hand writing
» Difficulty handling small objects (e.g. buttons, coins)

Tingling and loss of feeling in the thumb, pointer, middle and occasionally the ring finger.

Symptoms of Carpal Tunnel Syndrome

Severe or prolonged Median nerve compression causes it to dysfunction and results in classic symptoms of:

Hand and wrist pain:
» Aggravated by activity
» Aching or burning
» Often wakes you from sleep

Hand weakness and loss of dexterity:
» Frequently dropping things
» Poor hand writing
» Difficulty handling small objects (e.g. buttons, coins)

Tingling and loss of feeling in the thumb, pointer, middle and occasionally the ring finger.

Anatomy of the Carpal Tunnel

The Carpal Tunnel is located in the wrist and is a true tunnel with a floor, walls and a roof. The floor and walls are made of hard bones and the roof is made of a tough ligament. Within the tunnel are several firm tendons which bend the fingers. The Median nerve runs through this tunnel, and is very soft and delicate.

Anatomy of the Carpal Tunnel

The Carpal Tunnel is located in the wrist and is a true tunnel with a floor, walls and a roof. The floor and walls are made of hard bones and the roof is made of a tough ligament. Within the tunnel are several firm tendons which bend the fingers. The Median nerve runs through this tunnel, and is very soft and delicate.

Incidence of Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is the most common nerve compression syndrome, affecting 3%- 6%* of the world’s population, but is more common in women. More than 50%* of affected people have symptoms in both hands.

Risk Factors for Carpal Tunnel Syndrome

» Hyopothyroidism
» Water retention
» Obesity
» Diabetes
» Hand and wrist arthritis
» Wrist injury/fracture
» Activity
» Repetitive wrist and hand use
» Forceful or repetitive gripping
» Prolonged pressure on the wrist or hand
» Prolonged wrist flexion or extension
» Cold temperatures

Diagnosing Carpal Tunnel Syndrome

If you think you have Carpal Tunnel Syndrome, please see your Doctor. Left untreated, the nerve damage can be irreversible. Your Primary Care Doctor may refer you to a Hand Surgeon.

To diagnose Carpal Tunnel Syndrome, your Doctor will:

» assess your risk factors
» discuss your symptoms
» review any treatments you may have tried
» perform a physical examination to detect nerve compression
» patients with unusual symptoms or physical examination findings may require additional tests, such as x-rays, ultrasound, MRI or electro-diagnostic studies.

Incidence of Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is the most common nerve compression syndrome, affecting 3%- 6%* of the world’s population, but is more common in women. More than 50%* of affected people have symptoms in both hands.

Risk Factors for Carpal Tunnel Syndrome

» Hyopothyroidism
» Water retention
» Obesity
» Diabetes
» Hand and wrist arthritis
» Wrist injury/fracture
» Activity
» Repetitive wrist and hand use
» Forceful or repetitive gripping
» Prolonged pressure on the wrist or hand
» Prolonged wrist flexion or extension
» Cold temperatures

Diagnosing Carpal Tunnel Syndrome

If you think you have Carpal Tunnel Syndrome, please see your Doctor. Left untreated, the nerve damage can be irreversible. Your Primary Care Doctor may refer you to a Hand Surgeon.

To diagnose Carpal Tunnel Syndrome, your Doctor will:

» assess your risk factors
» discuss your symptoms
» review any treatments you may have tried
» perform a physical examination to detect nerve compression
» patients with unusual symptoms or physical examination findings may require additional tests, such as x-rays, ultrasound, MRI or electro-diagnostic studies.

Incidence of Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is the most common nerve compression syndrome, affecting 3%- 6%* of the world’s population, but is more common in women. More than 50%* of affected people have symptoms in both hands.

Risk Factors for Carpal Tunnel Syndrome

» Hyopothyroidism
» Water retention
» Obesity
» Diabetes
» Hand and wrist arthritis
» Wrist injury/fracture
» Activity
» Repetitive wrist and hand use
» Forceful or repetitive gripping
» Prolonged pressure on the wrist or hand
» Prolonged wrist flexion or extension
» Cold temperatures

Diagnosing Carpal Tunnel Syndrome

If you think you have Carpal Tunnel Syndrome, please see your Doctor. Left untreated, the nerve damage can be irreversible. Your Primary Care Doctor may refer you to a Hand Surgeon.

To diagnose Carpal Tunnel Syndrome, your Doctor will:

» assess your risk factors
» discuss your symptoms
» review any treatments you may have tried
» perform a physical examination to detect nerve compression
» patients with unusual symptoms or physical examination findings may require additional tests, such as x-rays, ultrasound, MRI or electro-diagnostic studies.

Treatment of Carpal Tunnel Syndrome

Dr. Penello’s Recommendations

If symptoms are mild or intermittent, non-operative treatment is attempted first. This involves:

» managing and treating risk factors (thyroid, arthritis)
» modifying activities (ergonomics, grip, repetitive wrist motion)
» wearing a proper splint during certain activities and at night
» desensitizing the Median nerve
» reducing Median nerve inflammation
» physical therapy

If symptoms are severe or constant, Carpal Tunnel Release surgery will be necessary to rapidly relieve pressure on the nerve and prevent or limit any permanent damage.

Treatment of Carpal Tunnel Syndrome

Dr. Penello’s Recommendations

If symptoms are mild or intermittent, non-operative treatment is attempted first. This involves:

» managing and treating risk factors (thyroid, arthritis)
» modifying activities (ergonomics, grip, repetitive wrist motion)
» wearing a proper splint during certain activities and at night
» desensitizing the Median nerve
» reducing Median nerve inflammation
» physical therapy

If symptoms are severe or constant, Carpal Tunnel Release surgery will be necessary to rapidly relieve pressure on the nerve and prevent or limit any permanent damage.

Initial Treatment

Initial treatment for mild and moderate Carpal Tunnel Syndrome is non-surgical and includes wrist splints, local corticosteroid injections, and anti-inflammatory medication. The most recent Cochrane Review suggests that neutral wrist splints worn at night, and during certain daily activities such as computer use, are beneficial for the treatment of mild to moderate Carpal Tunnel Syndrome. The American Academy of Orthopaedic Surgeons also published evidence-based Clinical Practice Guidelines recommending the use of wrist splints based on studies that demonstrated splint use resulted in less pain, fewer nighttime symptoms, better function and improved electrodiagnostic test results.

PDF Download:
The American Academy of Orthopaedic Surgeons 2016 Clinical Practice Guideline on the Management of Carpal Tunnel Syndrome

Initial Treatment

Initial treatment for mild and moderate Carpal Tunnel Syndrome is non-surgical and includes wrist splints, local corticosteroid injections, and anti-inflammatory medication. The most recent Cochrane Review suggests that neutral wrist splints worn at night, and during certain daily activities such as computer use, are beneficial for the treatment of mild to moderate Carpal Tunnel Syndrome. The American Academy of Orthopaedic Surgeons also published evidence-based Clinical Practice Guidelines recommending the use of wrist splints based on studies that demonstrated splint use resulted in less pain, fewer nighttime symptoms, better function and improved electrodiagnostic test results.

PDF Download:
The American Academy of Orthopaedic Surgeons 2016 Clinical Practice Guideline on the Management of Carpal Tunnel Syndrome

Initial Treatment

Initial treatment for mild and moderate Carpal Tunnel Syndrome is non-surgical and includes wrist splints, local corticosteroid injections, and anti-inflammatory medication. The most recent Cochrane Review suggests that neutral wrist splints worn at night, and during certain daily activities such as computer use, are beneficial for the treatment of mild to moderate Carpal Tunnel Syndrome. The American Academy of Orthopaedic Surgeons also published evidence-based Clinical Practice Guidelines recommending the use of wrist splints based on studies that demonstrated splint use resulted in less pain, fewer nighttime symptoms, better function and improved electrodiagnostic test results.

PDF Download:
The American Academy of Orthopaedic Surgeons 2016 Clinical Practice Guideline on the Management of Carpal Tunnel Syndrome